Treatment of a complicated penetrating ulcer of the descending thoracic aorta using a scalloped stent graft.

We show the use of a proximal scalloped stent graft for an pseudoaneurysm of the descending thoracic aorta to avoid occlusion of the left subclavian artery. A 63-year-old man with sudden onset dysphonia was diagnosed with left vocal fold paralysis and the presence of a lung mass. A computed tomography scan revealed saccular dilatation of the aortic arch (proximal neck: <10 mm) with suggestive images of a penetrating ulcer and degenerative pseudoaneurysm. A RELAY Plus thoracic stent graft (Bolton Medical, Sunrise, FL) with proximal scallop was implanted to preserve the left subclavian artery. A custom made prosthesis with proximal scallop provides a good alternative to a carotid-subclavian bypass because it is less aggressive and can be used in nonurgent cases.

Estudio mediante linfogammagrafía isotópica del edema postquirúrgico tras cirugía del sector fémoro-poplíteo / Lymphoscintigraphy study of oedema after femoropopliteal segment surgery

Introducción: El edema postcirugía del sector femoropoplíteo es una complicación frecuente, no relacionada con la gravedad de los síntomas previos ni con los cambios en la PA distal posterior. El objetivo del estudio es evaluar si el edema observado en los pacientes intervenidos de bypass femoropoplíteo es de causa linfática, y la posible influencia del tipo de prótesis utilizada y del tipo de intervención. Pacientes y métodos: Estudio analítico observacional de casos control con 30 pacientes intervenidos de bypass femoropoplíteo. Se ha realizado linfogammagrafía isotópica del sistema linfático superficial y profundo de ambas extremidades en todos los pacientes seleccionados para el estudio. Resultados: Se utilizó vena safena en 19 pacientes y PTFE en 11. Quince pacientes fueron controles (sin edema) y 15 casos (con edema). Tipo de cirugía: 9 reconstrucciones a primera porción de poplítea (1.a p.p.), 18 a tercera porción de poplítea (3.a p.p.) y 3 a ramas distales. Hallazgos gammagráficos: en las 30 exploraciones se observó asimetría del drenaje linfático entre las 2 extremidades, excepto en 1 caso (que no presentó edema). En 5 no había drenaje linfático (uno desarrolló edema). Se compararon casos con controles y pacientes con injerto autólogo y sintético, así como derivaciones por encima y por debajo de la rodilla. La única significación estadística que se obtuvo fue que estos últimos desarrollaron edema con mayor frecuencia que los practicados proximalmente a la rodilla. Conclusión: Por tanto los hallazgos linfogammagráficos no apuntan al daño linfático como causa del edema postcirugía femoropoplítea. Tampoco el material utilizado parece tener influencia. Las derivaciones infrageniculares sufren más edema que las suprageniculares (AU)

Introduction: Post-surgical oedema of the femoropopliteal segment is a frequent complication, unrelated to the severity of the previous symptoms or changes in subsequent distal arterial pressure. The aim of the study is to assess whether the oedema present in femoropopliteal bypass patients is of lymphatic origin, and the possible influence of the prosthesis and the type of intervention used. Patients and methods: An analytical, observational and case-control study of 30 patients who had a femoropopliteal bypass. Isotopic lymphoscintigraphy of the superficial and deep lymphatic system was performed on both limbs in all patients selected for the study. Results: The saphenous vein was used in 19 patients and PTFE in 11. The patients were divided into controls, 15 without oedema, and cases, 15 with oedema. Surgery technique: 9 reconstructions of the popliteal portion (1st p.p.), 18 third popliteal portion (3rd p.p.), and 3 distal branches. Scintigraphy findings: Asymmetric lymphatic drainage between the 2 limbs was observed in the all 30 examinations, except 1 case (which did not have oedema). There was no lymphatic drainage in 5 cases (one developed oedema). Cases with controls and patients with an autologous or synthetic graft, as well as shunts above and below the knee, were compared. The only statistical difference obtained was that the latter developed oedema more often than those performed close to the knee. Conclusions: Therefore, the scintigraphy findings did not point to lymphatic damage as a cause of post-femoropopliteal surgery oedema. The material used did not appear to influence this. The below-knee shunts suffered more oedema than those above the knee (AU)

[Lymphoscintigraphy study of oedema after femoropopliteal segment surgery]. / Estudio mediante linfogammagrafía isotópica del edema postquirúrgico tras cirugía del sector fémoro-poplíteo.

INTRODUCTION: Post-surgical oedema of the femoropopliteal segment is a frequent complication, unrelated to the severity of the previous symptoms or changes in subsequent distal arterial pressure. The aim of the study is to assess whether the oedema present in femoropopliteal bypass patients is of lymphatic origin, and the possible influence of the prosthesis and the type of intervention used. PATIENTS AND METHODS: An analytical, observational and case-control study of 30 patients who had a femoropopliteal bypass. Isotopic lymphoscintigraphy of the superficial and deep lymphatic system was performed on both limbs in all patients selected for the study. RESULTS: The saphenous vein was used in 19 patients and PTFE in 11. The patients were divided into controls, 15 without oedema, and cases, 15 with oedema. Surgery technique: 9 reconstructions of the popliteal portion (1st p.p.), 18 third popliteal portion (3rd p.p.), and 3 distal branches. Scintigraphy findings: Asymmetric lymphatic drainage between the 2 limbs was observed in the all 30 examinations, except 1 case (which did not have oedema). There was no lymphatic drainage in 5 cases (one developed oedema). Cases with controls and patients with an autologous or synthetic graft, as well as shunts above and below the knee, were compared. The only statistical difference obtained was that the latter developed oedema more often than those performed close to the knee. CONCLUSIONS: Therefore, the scintigraphy findings did not point to lymphatic damage as a cause of post-femoropopliteal surgery oedema. The material used did not appear to influence this. The below-knee shunts suffered more oedema than those above the knee.

[Prevalence of renal artery stenosis in patients with critical limb ischemia]. / Prevalencia de estenosis de la arteria renal en los pacientes con isquemia crónica grave de extremidades inferiores.

BACKGROUND AND OBJECTIVE: Our purpose was to evaluate the prevalence of renal artery stenosis in patients with critical limb ischemia and to study any clinical or laboratory indicator that could predict this association. PATIENTS AND METHOD: One hundred consecutive patients with critical limb ischemia evaluated by angiogram were included in the study from January to July 2003. Cardiovascular risk factors and renal function were analyzed. RESULTS: One hundred angiographic studies have been analyzed. Thirty nine (39%) of our patients had some type of pathology of the renal artery but the rest, 61 (61%), had normal and healthy renal arteries. In 5 patients, a bilateral renal pathology was found. Severe disease (> 60% stenosis, bilateral or renal occlusion) was present in 15 cases including 6 occlusions. Once we compared the patients with healthy renal arteries with the patients with different degrees of stenosis, we did not appreciate significant differences in hypertension, diabetes, coronary disease or smoking habit, nor with laboratory data such as creatinine, urea, c-reactive protein, total cholesterol or atherogenic index. No differences were found either comparing patients with normal renal artery with patients with bilateral pathology or with unilateral occlusion. CONCLUSIONS: There is a high prevalence of renal artery pathology in patients with critical limb ischemia although we have not found any clinical or laboratory factors useful to identify them.

Prevalencia de estenosis de la arteria renal en los pacientes con isquemia crónica grave de extremidades inferiores / Prevalence of renal artery stenosis in patients with critical limb ischemia

Fundamento y objetivo: Evaluar la prevalencia de la estenosis de la arteria renal en los pacientes con isquemia grave de las extremidades inferiores, y estudiar si existe algún indicador clínico o analítico que pueda ser útil para diferenciar a la población con enfermedad renal del resto de pacientes. Pacientes y método: Se ha estudiado prospectivamente mediante arteriografía renal a 100 pacientes ingresados de forma consecutiva en nuestro servicio por isquemia crónica de extremidades inferiores entre enero y julio de 2003. Se analizaron los factores de riesgo cardiovascular y la función renal mediante analítica. Resultados: Se realizaron 100 arteriografías. En 39 (39%) se observó enfermedad de arterias renales, mientras que éstas eran normales en 61 (61%). En 5 pacientes se encontró afectación bilateral. Se halló afectación grave (estenosis > 60%, afectación bilateral u obliteración renal) en 15 casos, que incluyeron 6 obliteraciones renales. Al comparar los pacientes que presentaban arteria renal sana con los que tenían una estenosis de la arteria renal no se obtuvieron diferencias respecto a la hipertensión arterial, diabetes mellitus, cardiopatía isquémica ni tabaquismo, y tampoco hubo diferencias en los parámetros analíticos estudiados: creatinina, urea, proteína C reactiva, colesterol total e índice aterogénico. Tampoco se hallaron diferencias al comparar el grupo de pacientes con arteria renal sana con aquellos que presentaban enfermedad bilateral o con los que presentaban oclusión de una arteria renal. Conclusiones: Existe una alta prevalencia de enfermedad vascular renal en los pacientes con isquemia grave de las extremidades inferiores. A pesar de ello, no hallamos ningún marcador clínico o analítico que la identifique

Background and objective: Our purpose was to evaluate the prevalence of renal artery stenosis in patients with critical limb ischemia and to study any clinical or laboratory indicator that could predict this association. Patients and method: One hundred consecutive patients with critical limb ischemia evaluated by angiogram were included in the study from January to July 2003. Cardiovascular risk factors and renal function were analyzed. Results: One hundred angiographic studies have been analyzed. Thirty nine (39%) of our patients had some type of pathology of the renal artery but the rest, 61 (61%), had normal and healthy renal arteries. In 5 patients, a bilateral renal pathology was found. Severe disease (> 60% stenosis, bilateral or renal occlusion) was present in 15 cases including 6 occlusions. Once we compared the patients with healthy renal arteries with the patients with different degrees of stenosis, we did not appreciate significant differences in hypertension, diabetes, coronary disease or smoking habit, nor with laboratory data such as creatinine, urea, c-reactive protein, total cholesterol or atherogenic index. No differences were found either comparing patients with normal renal artery with patients with bilateral pathology or with unilateral occlusion. Conclusions: There is a high prevalence of renal artery pathology in patients with critical limb ischemia although we have not found any clinical or laboratory factors useful to identify them

Análise dos resultados dos 100 primeiros aneurismas da aorta abdominal operados em um serviço de angiologia e cirurgia vascular / Outcome of the first 100 abdominal aortic aneurisms treated surgically in an angiology and vascular surgery service

Estudar as características dos pacientes e avaliar os resultados imediatos do tratamento cirúrgico dos 100 primeiros casos de aneurisma da aorta abdominal näo-rotos operados em um Serviço de Angiologia e Cirurgia Vascular, identificando os possíveis fatores prognósticos relacionados à mortalidade precoce...